与复发相关的和复发独立的贡献给整体扩大残疾状况尺度在多发性硬化症患者的进展,诊断在不同的时代
Noemi Montobbio1, Cinzia Cordioli2, Alessio Signori1
1Department of Health Sciences, University of Genoa, Genoa, Italy.
Annals of neurology
|October 9, 2024
概括
疾病修饰疗法通过减少复发相关恶化 (RAW) 和独立于复发活动的进展 (PIRA) 来减缓多发性硬化症 (MS) 的进展. PIRA越来越多地推动了MS的进展,强调了针对它的治疗方法的需要.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
背景情况:
- 疾病修饰疗法 (DMT) 减缓了多发性硬化症 (MS) 的进展.
- 与复发相关的恶化 (RAW) 和独立于复发活动的进展 (PIRA) 对这种减速的具体贡献尚未完全理解.
研究的目的:
- 为了研究RAW和PIRA在MS的演变作用,随着时间的推移,MS的过程减速.
- 评估不同时代的DMT对RAW和PIRA对残疾进展的相对贡献的影响.
主要方法:
- 在1980年至2022年期间诊断的1,405名复发性复发性MS患者中,对长期扩展残疾状态量表 (EDSS) 进展的回顾性分析.
- 通过将复发相关的EDSS变化从整体EDSS变化中扣除PIRA的隔离.
- 使用混合效应模型跨诊断时代 (预治疗,注射DMT,现代DMT) 的PIRA和RAW贡献的比较.
主要成果:
- 无论是PIRA还是RAW,都显示了最近时期诊断的患者的减少.
- 在所有时代,PIRA是EDSS进展的主要驱动因素,占78% (1980-1996) 和76% (1997-2008).
- 在2008年以后诊断的患者中,PIRA的贡献显著增加到87% (p=0.0009).
结论:
- 多发性多发性硬化过程的减速归因于RAW和PIRA的减少.
- 越来越多的PIRA突显了开发和评估针对复发独立进展的新疗法的关键需要.
- 未来的MS治疗策略必须考虑PIRA对长期残疾的显著和日益增长的影响.
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